Provider Demographics
NPI:1568290724
Name:MOTHERSBAUGH, KEIRA MORGAN
Entity type:Individual
Prefix:
First Name:KEIRA
Middle Name:MORGAN
Last Name:MOTHERSBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 LANSING RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2231
Mailing Address - Country:US
Mailing Address - Phone:330-310-3974
Mailing Address - Fax:
Practice Address - Street 1:1191 FENN RD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-3318
Practice Address - Country:US
Practice Address - Phone:330-310-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant